airway management nursing practices and processes

describes equipments and how to use them in airway management

1. Airway management

2. Most important question Is the airway patent? YES NO Patient is able to say his name No stridor or abnormal noise No secretions or blood in airway Patient is not able to say his name or is unable to open his mouth or very drowsy Stridor or abnormal noise present Secretions or blood in airway present

3. Look, Listen, Feel Standard assessment approach to be used in unresponsive patients Look for chest rise and fall Listen for breathing and any abnormal airway sounds Feel for breath

4. 4 Airway maneuvers Head tilt – Chin lift Jaw thrust

5. Oropharyngeal airway Nasopharyngeal airway Airway adjunct devices

6. Advanced airway devices ET tubes LMA

7. Indications for definitive airway Failure to maintain a patent airway and protect against aspiration Inadequate gag reflex and inability to handle secretions Decreased mental status (GCS < 8) not due to a rapidly reversible cause ( eg , hypoglycemia, opioid overdose) Severe maxillofacial trauma

8. Failure to adequately oxygenate or ventilate Hypoxemia unresponsive to supplemental oxygen, as measured by pulse oximetry with good waveform Hypercapnea , as measured by ABG or end tidal CO2 (ETCO2) with decreased mental status or other adverse effect. Indications for definitive airway

9. Anticipated clinical deterioration Status epilepticus , multiple trauma +/− head injury, certain overdoses (TCA), penetrating neck trauma, tiring asthmatic, etc. Indications for definitive airway

10. Clinical Scenario examples Head Injury patient – with poor GCS COPD patient – with CO2 retention Epileptic patient – with uncontrolled seizures Sepsis patient – with severe acidosis Face trauma patient – with oral bleeding Drug overdose patient – with respiratory depression

11. Checklist for equipments required for managing airway Personal protection equipments Monitor connected to patient – BP, SPO2, PR IV access, tourniquet Oxygen face mask, tubings OPA, NPA BMV device Suction device Laryngoscope and blades – all sizes

12. ET tubes all sizes Stillet , Bougie Syringe for inflating cuff Cuff manometer, stethoscope LMA RSI drugs IV fluids and drugs for cardiac arrest Infusion / syringe pumps Checklist for equipments required for managing airway

13. Tube securing tapes Ventilator and its tubing's ETCO2 monitor Transport team to shift to CXR bay for tube position confirmation Post intubation management Magill forceps Difficult airway devices Checklist for equipments required for managing airway

14. To Summarize… Always check airway patency for any patient presenting to the ER Always bear in mind – Look, Listen and feel Assign the roles of team leader, airway nurse and IV nurse All equipments and drugs should be checked regularly Knowledge regarding different airway devices, drugs and team work are essential for the better management of the patient